Atlas of Craniopharyngioma: Pathology, Classification and Surgery

166 Pages·2020·33.942 MB·English

by  Songtao Qi

Songtao Qi
Editor
Atlas of
Craniopharyngioma
Pathology, Classification and Surgery
123
Atlas of Craniopharyngioma
Songtao Qi
Editor
Atlas of Craniopharyngioma
Pathology, Classification and Surgery
Editor
Songtao Qi
Neurosurgery Department of Nanfang Hospital
Southern Medical University
Guangzhou
Guangdong
China
ISBN 978-981-13-7321-3 ISBN 978-981-13-7322-0 (eBook)
https://doi.org/10.1007/978-981-13-7322-0
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Foreword
This is a timely book. The application of endoscopy, new advanced media in imaging, surgical
preparation, intraoperative navigation, and imaging have quite literally opened up the surgical
view of deep-seated lesions in critical locations. Craniopharyngiomas are the quintessential
deep-seated, midline lesion surrounded by critical structures; this surgical atlas provides the
necessary surgical roadmap to guide these surgical journeys.
The author group, Prof Qi and his team at Nanfang Hospital, have accumulated a unique
experience with a wide range of surgical material and their insights and pearls are of immense
value to those who do not have the advantage of their catchment.
It will become a valuable addition in the operative arsenal of the neurosurgeon.
Nelson M. Oyesiku
Neurosurgery and Medicine (Endocrinology)
Emory University School of Medicine
Atlanta, GA, USA
Emory Pituitary Center
Emory University School of Medicine
Atlanta, GA, USA
Department of Neurosurgery
Emory University School of Medicine
Atlanta, GA, USA
v
Preface
Craniopharyngioma is defined by the WHO as an intracranial benign tumor that cannot be
cured due to anatomical factors. Surgery, radiotherapy, cystic aspiration, and internal irradia-
tion or intracapsular chemotherapy are considered as “proper” treatment options for cranio-
pharyngioma. Partial surgical resection combined with stereotactic radiotherapy is applied in
many medical centers, which results in craniopharyngioma being basically incurable, and even
if the patient has long-term survival, health is impaired and quality of life is low.
Since 1998, our team has treated approximately 1000 cases of primary and recurrent cranio-
pharyngioma for curative purposes. Approximately 800 cases were admitted in our centers and
received systematic clinical therapy. The total resection rate of primary craniopharyngioma
from 1998 to 2003 was approximately 85%, which has reached the level reported in the Yasargil
period, and the total tumor resection rate from 2004 to 2008 was nearly 90%. From 2009 to the
present (2018, May), the total resection rate is higher than 95% and there were no perioperative
deaths in the past three years.
We have progressed greatly in craniopharyngioma treatment in the past 20 years because
we have been focusing on the effects of tumor origin and membranous structures on the tumor
growth pattern through clinical, embryonic, and histological studies. The QST classification of
craniopharyngioma based on tumor origin and surrounding membranous structures was estab-
lished. This classification has the following advantages compared with the previous important
classification. First, this classification is in line with the embryonic origin theory and is not
concerned with the notion of “intra-third ventricle craniopharyngioma,” which leads to the
misconception that tumors can originate in the third ventricle. Second, some large and com-
plex craniopharyngiomas can be well classified by the QST system, and this system can more
accurately reflect the relationship between the tumor and important structures such as the
hypothalamus, so as to facilitate the correct surgical approach. Third, the QST system is not
only related to the symptoms, endocrine status, and pathological types of patients, but also
reflects the difficulty of surgery in different cases and accurately determines the prognosis.
The previous classifications may have not paid sufficient attention to the origin of the tumor.
Some classifications were only based on clinical observation and the experience of the surgeon
that did not emphasize the embryonic origin of craniopharyngioma. Some other classifications
are only based on the relative relationship between important structures and the tumor. Some
are even based on the relative position of the third ventricle, which also does not emphasize the
pathological relationship between the tumor and the hypothalamic tissue. These resulted in the
need for a long learning curve for doctors or lead to failure in successfully treating a cranio-
pharyngioma, and also lead to the view that craniopharyngiomas involving the third ventricle
floor are not suitable for surgical resection. This is also the root cause why conservative treat-
ments for craniopharyngioma are still advocated and the belief that this benign tumor cannot
be cured.
In the past 20 years, our team carried out systematic and comprehensive research on cranio-
pharyngioma. The chief editor of this atlas, Professor Qi Songtao, achieved a total resection
rate of 97% in approximately 600 craniopharyngioma cases. Some patients can maintain func-
tional hypothalamic-pituitary secretion and some patients even had restored fertility. The main
content of this atlas includes the development of craniopharyngioma from the embryonic
vii
viii Preface
perspective, the microanatomy of surrounding membranous structures, the histopathological
relationship between the tumor and the adjacent structures, and the QST classification and its
application in transcranial and transsphenoidal approaches.
Although craniopharyngioma has become a curable intracranial tumor in the author’s cen-
ter, it is undeniable that it is a task for neurosurgeons to deal with this benign tumor due to its
strategic location and malignant biological behavior. This is also the purpose of our atlas. We
will feel gratified if more patients can safely undergo total resection, rather than partial resec-
tion plus radiotherapy, chemotherapy, or immunotherapy.
Craniopharyngioma is a long-term disease in the clinical process. We have numerous col-
leagues in this field and cannot list them all in this book. However, their contribution will defi-
nitely be remembered forever.
Guangzhou, China Songtao Qi
2018-8-30
Contents
Part I T he Basics of Craniopharyngioma
1 H istology and Embryology Related to Craniopharyngiomas . . . . . . . . . . . . . . . . . . 3
Shi-chao Zhang and Chao-hu Wang
2 Surgical Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Xi’an Zhang, Yun-tao Lu, and Songtao Qi
3 Q ST Classification for Craniopharyngioma and Histopathological Aspect . . . . . . 13
Yi Liu, Chao-hu Wang, and Songtao Qi
4 C omparison Between the QST Scheme and Other Schemes
for Craniopharyngiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Yun Bao and Songtao Qi
Part II S urgical Treatment of Craniopharyngioma
5 Endoscopic Transsphenoidal Surgery for Craniopharyngioma . . . . . . . . . . . . . . . . 37
Jun Fan, Yi Liu, and Songtao Qi
6 S urgical Treatment of Craniopharyngioma: Transcranial Approach . . . . . . . . . . . 61
Jun Pan, Jun-xiang Peng, and Song-tao Qi
Part III Recurrent Craniopharyngioma
7 Treatment of Recurrent Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Jing Nie
Part IV O ther Aspects of Craniopharyngioma
8 Retreatment of Craniopharyngioma After External Radiotherapy and
Intracapsular Radiochemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Jun-xiang Peng, Yun Bao, and Songtao Qi
9 B asic Research in Craniopharyngioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Zhan-peng Feng, Yi Liu, Chao-hu Wang, and Songtao Qi
ix
About the Editor

Chief editor: Songtao Qi
Associate editors: Jun Pan, Yi Liu, Xi’an Zhang, and Jun Fan

Editors: from left to right sitting in the first row: Jun Fan, Xi-an Zhang, Songtao Qi, Jun Pan,
Yun-tao Lu, and Yi Liu; from left to right in the second row: Jing Nie, Jun-xiang Peng,
Jin Shi, Chao-hu Wang, Zhan-peng Feng, Shi-chao Zhang, and Yun Bao
xi
Part I
The Basics of Craniopharyngioma